A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study

Kellner, Charles H.; Husain, Mustafa M.; Knapp, Rebecca G.; McCall, W. Vaughn; Petrides, Georgios; Rudorfer, Matthew V.; Young, Robert C.; Sampson, Shirlene; McClintock, Shawn M.; Mueller, Martina; Prudic, Joan; Greenberg, Robert M.; Weiner, Richard D.; Bailine, Samuel H.; Rosenquist, Peter B.; Raza, Ahmad; Kaliora, Styliani; Latoussakis, Vassilios; Tobias, Kristen G.; Briggs, Mimi C.; Liebman, Lauren S.; Geduldig, Emma T.; Teklehaimanot, Abeba; Dooley, Mary; Lisanby, Sarah H.

doi:10.1176/appi.ajp.2016.16010118

Cited by 223 publications

(148 citation statements)

References 16 publications

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“…Although ECT is a safe treatment with a low risk of physical complications, there is still a risk of cardiovascular side effects such as severe bradycardia and asystole, particularly in patients with pre-existing cardiac diseases, status epilepticus or aspiration pneumonia in less compliant patients in terms of following the pre-ECT instructions 26 27. Preliminary data of the study on continuation ECT in geriatric depression (PRIDE study) demonstrated that continuation ECT is safe and effective in preventing relapse of major depression 28. The frequency of ECT sessions was four continuation ECT treatments over 1 month, plus additional ECT as needed 28.…”

Section: Resultsmentioning

confidence: 99%

“…Preliminary data of the study on continuation ECT in geriatric depression (PRIDE study) demonstrated that continuation ECT is safe and effective in preventing relapse of major depression 28. The frequency of ECT sessions was four continuation ECT treatments over 1 month, plus additional ECT as needed 28. Most of the research studies favouring continuation/maintenance ECT are coming from geriatric psychiatry and these research data cannot be simply translated to general adult population of patients with depression, particularly those in a working age group.…”

Section: Resultsmentioning

confidence: 99%

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Current status of electroconvulsive therapy for mood disorders: a clinical review

Kolář

2017

Evid Based Mental Health

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Electroconvulsive therapy (ECT) is an effective treatment for mood disorders and a viable treatment option especially when urgency of clinical situation requires a prompt treatment response. After acute series of ECT, the ECT long-term treatment may be considered, although this practice may vary significantly between countries or even within the same country, because there is no universal consensus about its indications, duration and frequency of administration. Continuation or maintenance ECT is common in routine clinical practice and clinicians should be aware of the risks of using ECT long term. Neuropsychological assessment should be an essential part of a good clinical practice in ECT services. Cognitive side effects of ECT are sometimes underestimated and may last much longer after completed treatment than it is usually expected. These cognitive impairments associated with ECT may cause significant functional difficulties and prevent patients to return to work. Cognitive assessment during ECT treatment is usually not comprehensive enough and is limited to bedside assessment. A more proactive approach to careful neuropsychological assessment and consideration of combined maintenance medication treatment after ECT are essential.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Current status of electroconvulsive therapy for mood disorders: a clinical review

Kolář

2017

Evid Based Mental Health

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“…Dolenc and Rasmussen [4] provide a report of 12 cases where ECT and lithium were safely combined without adverse effects. Phase 2 of the PRIDE study showed no remarkable adverse effects for geriatric patients receiving a combination of ECT and a regimen of venlafaxine and lithium [16][17][18][19][20]. A prospective study [12] assessing this combination resulted in no significant differences in seizure variables, apnea time, and recovery from anesthesia.…”

Section: Introductionmentioning

confidence: 99%

A Case Report of ECT and Muscle Spasms

Turner¹,

Gunther²,

Husain³

et al. 2017

J Pharmacovigilance

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“…Even with these approaches, a substantial number of individuals will still have recurrent symptoms within 6 months of an acute ECT course. The articles by Kellner et al (5,6) in this issue of the Journal examine whether continuation ECT in combination with medication can maintain the acute antidepressant effects of ECT with acceptable tolerability and greater efficacy than continuation medication treatment alone.In phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study (5), patients age 60 or older with unipolar depression received venlafaxine (in dosages of up to 225 mg/day) in combination with three-times-a-week right unilateral ultrabrief pulse ECT at a stimulus dose of six times seizure threshold. Of the 240 patients who began phase 1, remission was achieved in 61.8%, 28.3% did not complete the trial, and 10.0% were nonremitters.…”

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confidence: 99%

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confidence: 99%

Evidence for the Continuing Benefits of Electroconvulsive Therapy

Fochtmann

2016

AJP

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Electroconvulsive therapy has been an important part of the psychiatric armamentarium for over 75 years. Although ECT is most often used as a treatment for depression, its benefits have also been demonstrated in patients of all ages with catatonia, mania, and, under some circumstances, schizophrenia and schizoaffective disorder (1). Early in its history, ECT was the only available somatic treatment that was effective for severe psychiatric illness. However, with older techniques for ECT administration, side effects (including effects on cognition) were common. With the advent of psychotropic agents and concerns about ECT tolerability, its use became less frequent. Negative media portrayals fueled stigma about ECT and added to controversies about appropriate use. Despite all this, ECT remains our "go to" treatmentthe approach that clinical studies and experience tell us is most likely to elicit a rapid and robust response, even with severe symptoms that have not responded to other interventions.As with virtually all treatments in medicine, there are aspects of ECT that could be improved further. To maintain ECT benefits while minimizing cognitive effects, active foci of investigation have included new approaches: changing stimulus parameters, modifying electrode placements, prescribing adjunctive medications, or administering psychotherapy. Another challenging aspect of ECT practice is helping individuals remain well once ECT has exerted a salutary effort. Studies have shown that treatment with lithium in combination with nortriptyline after an index course of ECT can reduce relapse rates compared with placebo (2). Other research shows lithium plus venlafaxine (3) or continuation ECT alone (4) to have relapse rates comparable to those for lithium plus nortriptyline. Even with these approaches, a substantial number of individuals will still have recurrent symptoms within 6 months of an acute ECT course. The articles by Kellner et al. (5,6) in this issue of the Journal examine whether continuation ECT in combination with medication can maintain the acute antidepressant effects of ECT with acceptable tolerability and greater efficacy than continuation medication treatment alone.In phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study (5), patients age 60 or older with unipolar depression received venlafaxine (in dosages of up to 225 mg/day) in combination with three-times-a-week right unilateral ultrabrief pulse ECT at a stimulus dose of six times seizure threshold. Of the 240 patients who began phase 1, remission was achieved in 61.8%, 28.3% did not complete the trial, and 10.0% were nonremitters. This remission rate was about twice that for antidepressants in comparable populations, although it was slightly lower than rates in previous studies that used brief pulse ECT. Also, compared with studies of antidepressants, ECT trials typically enroll patients with more severe symptoms (7), and phase 1 of the PRIDE trial was no exception. The mean Clinical Global Impressions severity score was in the "ma...

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A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study

Cited by 223 publications

References 16 publications

Current status of electroconvulsive therapy for mood disorders: a clinical review

Current status of electroconvulsive therapy for mood disorders: a clinical review

A Case Report of ECT and Muscle Spasms

Evidence for the Continuing Benefits of Electroconvulsive Therapy

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